# NORTHEAST OBSTETRICS & GYNECOLOGY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** NORTHEAST OB-GYN, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811941024
- **Authorized official:** MRS. TAMARA A FURNISS (BUSINESS MANAGER)
- **Authorized official phone:** (260) 426-7755

## Contact information

- **Practice address:** 11123 PARKVIEW PLAZA DR, SUITE 101, FORT WAYNE, IN 46845-1707
- **Practice address phone:** (260) 422-7455
- **Practice address fax:** (260) 424-9356
- **Mailing address:** 11123 PARKVIEW PLAZA DR, SUITE 101, FORT WAYNE, IN 46845-1707
- **Mailing address phone:** (260) 422-7455
- **Mailing address fax:** (260) 424-9356

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 50001834A | IN | Yes |

## Other

- **Enumeration date:** 05/20/2006
- **Last updated:** 06/24/2008